Reimbursement Specialist

at Walgreens

Job Description

The position(s) described here are for Option Care (previously known as Walgreens Infusion Services), a former subsidiary of Walgreen Co. (Walgreens). Option Care became a new independent, privately-held company on 4/7/2015 following the acquisition of a majority interest in the company by Madison Dearborn Partners, a leading private equity firm based in Chicago. Walgreens will retain a significant minority interest in the new company and will have representatives on the company’s board of directors. As such, Walgreens will continue to have a role in ensuring the future success of the new company.

Job Duties Include: Responsible for the timely, accurate submission of invoices to responsible payer, of any type, for all services and products provided. Evaluates payments received and application to the patient account. Follows-up with responsible parties to ensure the receipt of timely, accurate payments. Assists with Billing and Collection Training and completes "second level" appeals to payers. Submits timely, accurate invoices to payer for products and services provided. Understands the terms and fee schedule for all contracts for which invoices are submitted. Correctly determines quantities and prices for drugs billed. Verifies that the services and products are correctly authorized and that required documentation is on file. Ensures that invoices are submitted for services and products that are properly ordered and confirmed as provided.

Evaluates payments received for correctness and applies payments accurately to the system. Verifies that payments received are correct according to the fee schedule. Applies the payment correctly to the patient account. Ensures that secondary bills and patient invoices are mailed within 48 hours of receipt of payment. Notifies the Reimbursement Manager if there are overpayments and/or duplicate payments for the same service. Transfers payments belonging to other offices within 48 hours of receipt. Follows up on invoices submitted to ensure prompt and timely payment. Calls to verify that claims submitted were received and are in processing. Sends letters to the patient or responsible party when their insurance carrier fails to make payment reasonable time frame. Generates and mails statements and collections letters per Walgreens policy. Follows-up on all denials within 48 hours of receipt.